Chapter Six - "Help Me --- I'm Tired Of Feeling Bad"

Chapter Six

Direct Therapeutic Nurture

When we have asked a patient to journey back on the wings of pain to childhood trauma, it is somewhat equivalent to taking a baby out for a Sunday walk, torturing it in the baby carriage, and finally abandoning it in the rubble of a bombed-out city. It requires pain to return to childhood and, once we arrive there, we are usually greeted with a psychological wasteland. When we enter into the desolation of a childhood which has been deprived of love, deprived of touch, deprived of empathy and filled with abuse, what do we do with an adult who has now become a baby and whose Central Nervous System is wide open to feel its pain, wide open in a world without nurture? The answer is obvious. We do not leave this psychological infant to die of exposure in some new and grotesque Roman tradition. You will remember the Romans killed babies for a variety of reasons by abandoning them on a hill side.

I do not abandon my psychological children and once again this requires pushing forward into a strictly forbidden zone. I do provide what I would call `direct therapeutic nurture,' the third mechanism which I am naming as a new and legitimate therapeutic phenomenon.

What does direct therapeutic nurture mean?

First, to match the intensity of Level Four vulnerability, the therapist must be intensely present. In my case this means many things. I lie sometimes very close to my patients without actually touching them, peering at them through the gloom so that if they open their eyes they will see a face of caring that they never saw early in their life.

Second, direct therapeutic nurture means touch. I touch my patients in a variety of non-sexual ways. I might put a hand on a hand, a hand on an arm, a hand on a back, on a neck, on a face, on a head as a father would touch a child who is in pain.

In the use of touch for feeding and nurture, I might place a hand on someone's abdomen, on top of or underneath clothing, where their bodies can drink in the warmth, skin to skin if necessary. In deep, regressive therapy we recognize body hunger and skin hunger.

Skin hunger is well known in the world of infants. Lack of skin contact gives rise to depression and death. This process in infants has been well known since the studies of Spitz and Bowlby conducted before World War II. In foundling homes, babies fed and kept clean experienced depression, and finally death, unless they were touched.

More recently premature infant death rates fell sharply when babies were placed on sheepskin rugs instead of sheets. The texture saved their lives. In the world of the young child, touch and life are synonymous.

Feeding with direct touch is the second body necessity just as searching for congruence is the first body necessity. Where human beings have not been satisfied by good nurturing in infancy, there remains an intense need for holding and touch. This normally gives rise during and after adolescence to the use of sexuality as a tool for obtaining relief. How many times have I heard women say, `If only he could hold me without becoming sexual.' In therapy I hold damaged people without becoming sexual. We hold to regress and we hold to heal. Sometimes the same gesture will combine both.

For example, a young woman psychotherapist came to me for depression and severe panic around moments of plunging self-esteem. She was terrified that in her new marriage her husband would find nothing of value in her to sustain his love. She trembled in panic at any negative look and felt that she would disintegrate.

During our work, this patient developed severe abdominal discomfort. Obeying an intuitive sense, I placed my hand on her abdomen. Her stomach started to heave violently. I rolled toward her to offer her physical support by holding her. I wanted to help her contain a rapidly rising tidal wave of physical and emotional pain.

She had also turned toward me and so we came, as so often happens by mutual consent, to a position of holding which was a tight full frontal embrace. The heaving of her abdomen increased. I then felt it necessary to place my hand in the small of her back and press her abdomen even more tightly against mine.

She began to scream, her body was racked with the convulsions and the sounds that she made were loud and frightening. Gradually her voice changed and became more infant-like. Sessions like this continued for months and no insight emerged.

In addition to an absolutely rejecting father and an angry, undermining mother, I sensed there must be some other trauma. I asked her if she had suffered any other serious hurt as a young child. She told me that she was hospitalized for several weeks, under the age of eleven months, with an intense gastro-intestinal disorder. She did not see her mother during this time. Research has shown that abandonment of an infant under the age of eleven months can give rise to irreparable damage. As she convulsed against me, she screamed over and over again, 'Don't leave me.' When I said that I would not, she needed to pull back and carefully examine my face to ascertain whether or not she could trust me. Strangely enough, after this re-experiencing of an infantile problem, her panic attacks around low self-esteem began to subside. It seems that infant abandonment, even for a few weeks, can send ripples down through the decades and wreck self-esteem in adult intimacy.

Here we see holding both provoking and healing childhood trauma at the same time. Where intense physical presence is needed to contain a pain-shattered ego, or to heal catastrophic levels of early childhood deprivation, the touching must be very close indeed.

As Anna Freud pointed out in her book on the mental mechanisms of defence, the intensity of the defence is equal to the intensity of the damage. In my world this means that where serious childhood damage has occurred, equally serious or equally intense reparative work must occur. It must also obey the rule of congruence: it must be exactly correct.

For example, in the case of the last patient who screamed and regressed to nine months of age, she only did so when I pressed my abdomen against hers. No intensity of hand-holding or verbal urging would have provided the necessary key.

During her moments of regression, I was the maternal lifeline, the nurturing event before her revisited potential infant death. She clung to me with the intensity of a concentration-camp victim being taken to the ovens. I clung back with a powerful, empathic human response. I could have done nothing else.

Congruence having been achieved, and having utilized the abdominal pain in the present, we quickly found ourselves in the deep preverbal past. The gastro-intestinal emergency was being re-experienced, along with the infant's death-dealing feelings of abandonment.

In the area of therapeutic touch skin-to-skin contact is an extremely important issue. Skin-to-skin contact is profound, powerful and necessary for the unfolding of the infant's mind/body structures.

I believe that during adolescence an emotional shunt occurs. This shunt is analogous, in the emotional realm, to the closing of the hole between the left and right sides of the heart, immediately after birth, which causes blood flow to begin picking up oxygen in the infant's lungs instead of picking it up from the maternal umbilical supply.

In adolescence, touching of the skin shifts much of its internal significance from direct nurture to sexual arousal.

The dual nature of touch gives rise to a serious problem in regressive psychotherapy. When an adult regresses to a childhood or infantile state, direct touch is often called for. There is, however, always an adult present in the patient. The adult can allow sexuality to emerge, or can choose the nurture side of the NURTURE-SEXUAL SHUNT. What might have been sexual becomes a nurturing event. If there is some spillover into sexual arousal, the adult in both the patient and the therapist can work to neutralize it. Indeed, the nurturing aspect becomes so dominant that the patient begins to experience it as a core and lifesaving event.

Clearly great care must be exercised in these nurturing experiences. Much trust and goodwill are needed. Are there not many times in medicine where great care is needed?

One of the most profound neutralizers of adult terror is the placing of one abdomen against another. The calming effects of this experience are enhanced tenfold if clothing is drawn back from the abdominal area. The relief from deep fear and despair that this kind of touch occasions is dramatic and immediate. We have all experienced this kind of comfort in an attenuated form during adult hugging.

It is possible to utilize this technique during regressive therapy to achieve profound calming and deep nurture. Care must be taken to avoid sexual movements of the pelvis.

One of my patients, who made use of this technique to alleviate severe anxiety and convulsive crying, referred to these moments as tummy hugs.

It is a comment on our civilization, at this time in its development, that such a simple organic and effective neutralizer of terror in depth therapy might be looked upon with intolerance.

If we stop to consider for a moment, we will recall that the most joyous thing a new mother can do is to place her infant child upon her abdomen. This expresses her love in a powerful skin-to-skin catalyst of early growth for her child. Skin-to-skin nurture is the physical base upon which psychological health builds. It is the uttermost ground of the healthy personality.

Where deep regressive therapy occurs, physical re-parenting may be an absolute necessity. Some patients seem to be able to do extraordinarily deep regressive work without requiring any touch from their therapists. Others cannot handle the extreme intensity of these painful regressions without a great deal of touch and deep physical connectedness.

Over and over again, when therapists supply this kind of nurturing they caution their patients not to talk about it under any circumstances. The time has come for this fearfulness and dishonesty to end. If we can make nuclear energy safe, we can make deep nurture safe.

The Sense of Smell in Human Growth

In the area of direct touch, there is another issue related to the issue of direct skin contact. I noticed over and over again when holding women patients, that they would bury their faces in the base of my neck where the open top button of my shirt left a small V-shaped area of skin exposed. I began to loosen the top of my shirt so that patients could lay the skin of their faces against the skin of my neck. Skin-to-skin contact often seemed to be sought in this way, even though it is not an easy position in which to breathe.

I then realized that breathing was precisely the issue at stake here. Patients were seeking reassurance through their sense of smell just as lower mammals do. Anyone who has ever owned a dog or cat is familiar with this. Although somewhat vestigial, the olfactory lobes of the brain, which bring us our sense of smell, are still relatively large in our species.

The attempt to get physically closer and closer to a therapist provides a base of bonding which facilitates the introjection of a new parental substitute. This re-parenting effect with its subsequent internalization on the part of the patient, provides a new and sturdier ground for the personality. This is especially true where the initial parents were too depriving or damaging.

Extreme closeness to a therapist in this way during Level Four regressive psychotherapy, for some people, is an absolute psycho-physiological necessity. As I have said earlier, extreme physical closeness between therapist and patient is the second body necessity in Level Four depth therapy. The first, you will recall, was the search for congruence of which we have spoken.

Two of my patients reported to me that during periods of insomnia, or after a nightmare, they would fantasize my presence in a non-sexual way to neutralize their anxiety. One fantasizes my holding her, another fantasizes my stroking the back of her neck. With these fantasies comes an alleviation of the anxiety and a return to sleep. Yet another asked if I would tear off a piece of my shirt so that she could hold it against her face and take in the scent of my body to calm her between sessions. She was thereby utilizing a parent substitute object for the dual purpose of stimulating her sense of both touch and smell. These patients are obviously attempting to take in, or introject, a parent substitute object which will more fully reassure them then did their original parents. This shores up and makes stronger the ground of their personality systems in the face of these traumatic re-experiencings. This is what I mean when I talk about intense therapist presence during Level Four regressive psychotherapy. You will note that this kind of presence in no way interferes with the patient's inner processes in terms of insight production. In fact, it is a catalyst for precisely these deeper insights.

Touch is as necessary for physiological and psychological unfolding, as vitamins are during pregnancy, to the unfolding of intellectual competence.

When I first discovered touch and holding as powerful facilitators in the late 1970s, I made a number of errors. First I failed to separate them from each other clearly. Often they are very separate and sometimes they are very similar.

Direct touch to trigger early re-living usually works very well. You will recall the man with the ulcer in the early part of this book. Cases such as this are quite common. Direct touch can provoke regression or it can be used for physical reassurance and containment. For example, when someone is approaching deep negative feelings, a hand placed firmly in the centre of that person's back will often give them the support necessary to allow these powerful feelings to come forward.

Holding also, as we have seen, can facilitate or contain overwhelming feelings. In the early years of exploring these techniques, I made a serious error on a number of occasions by using holding to facilitate a return to the childhood state before the patient felt the need of it. In short, I ceased to be client-centred. The result of this was that several patients became upset with me and felt intruded upon rather than facilitated. I learned the old lesson of therapy which is: to walk beside a patient or behind a patient, but to be extraordinarily careful when walking in front using a powerful facilitative process. I learned that holding can only be used when powerful client need calls it forth in an organic way. Holding, before it is needed, may be felt as incongruent, invasive and possibly sexual. Holding, before it is needed, may deepen therapy too quickly with various unproductive results, and is rightfully perceived as hurtful.

Touch and holding must be needed, wanted, and requested within a self that comprehends what is being asked for. That self must be deeply committed to experiencing and must have sufficient strength to contain and work through the powerful feelings that will emerge.

When one is truly at work within Level Four depth psychotherapy, touch and holding are a warm and safe hearth in a desperate storm.

Sexual Touch

I have come to understand that sexual touch is impossibly difficult to use. It has become clear to me that most patients who request it have no idea how badly it will upset them.

Sexuality is a separate ocean in a patient's world. Deep, treacherous, wracked by storms -- and most especially so when there has been sexual abuse in childhood.

The terrible and complicating truth about sexual touch is that in addition to triggering a re-living of childhood trauma, it may ignite the mating processes of the brain. This can give rise to powerful expectations of love, feelings of abandonment, jealousy, rage, and the whole gamut of responses to which "love" is prey. In turn, these feelings can overwhelm the damaged ego container of the client and, indeed, of the therapist, and spill over into the therapy with disastrous results.

As if these problems weren't enough, the defensive forces of the brain may seize upon the therapist as the source of pain, thereby avoiding the frightening early primal work. As I say elsewhere, it is easier to destroy the therapist than it is to face our early molestation.

And yet, Masters and Johnson, and other sexual researchers, have used direct sexual techniques and surrogate partners, in an ever-widening area of innovation. My treatment of the patient who could only re-live her childhood sexual abuse by touching me, stands in my mind as ethical therapy.

But therapists must be on guard as to whether a request for sexual touch is coming from impulses which are unhealthy, as opposed to a Level Four body necessity which is searching for congruence to enable a therapeutic re-living.

Even with this understanding I do not feel that I could ever risk using sexual touch again. Instead, I have turned to the use of therapeutic sexual models. For example, a long hard object under a blanket has caused one of my clients to effectively re-live an early molestation.

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